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Patrick S. Ramsey - One of the best experts on this subject based on the ideXlab platform.
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Progestogen for preventing miscarriage in women with recurrent miscarriage of unclear etiology
Cochrane Database of Systematic Reviews, 2018Co-Authors: David M. Haas, Taylor J Hathaway, Patrick S. RamseyAbstract:Background Progesterone, a female sex hormone, is known to induce secretory changes in the lining of the uterus essential for successful implantation of a fertilized egg. It has been suggested that a causative factor in many cases of miscarriage may be inadequate secretion of progesterone. Therefore, clinicians use Progestogens (drugs that interact with the progesterone receptors), beginning in the first trimester of pregnancy, in an attempt to prevent spontaneous miscarriage. This is an update of a review, last published in 2013. Objectives To assess the efficacy and safety of Progestogens as a preventative therapy against recurrent miscarriage. Search methods For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (6 July 2017) and reference lists from relevant articles, attempting to contact trial authors where necessary, and contacted experts in the field for unpublished works. Selection criteria Randomized or quasi-randomized controlled trials comparing Progestogens with placebo or no treatment given in an effort to prevent miscarriage. Data collection and analysis Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Two reviewers assessed the quality of the evidence using the GRADE approach. Main results Thirteen trials (2556 women) met the inclusion criteria. Nine of the included trials compared treatment with placebo and the remaining four trials compared Progestogen administration with no treatment. The trials were a mix of multicenter and single-center trials, conducted in Egypt, India, Jordan, UK and USA. In six trials women had had three or more consecutive miscarriages and in seven trials women had suffered two or more consecutive miscarriages. Routes, dosage and duration of Progestogen treatment varied across the trials. The majority of trials were at low risk of bias for most domains. Eleven trials (2359 women) contributed data to the analyses.The meta-analysis of all women, suggests that there is probably a reduction in the number of miscarriages for women given Progestogen supplementation compared to placebo/controls (average risk ratio (RR) 0.69, 95% confidence interval (CI) 0.51 to 0.92, 11 trials, 2359 women, moderate-quality evidence). A subgroup analysis comparing placebo-controlled versus non-placebo-controlled trials and different routes of administration showed no differences between subgroups for miscarriage. However, there appears to be a subgroup difference for miscarriage between women with three or more prior miscarriages compared to women with two or more miscarriages, with a more pronounced effect in women with three or more prior miscarriages. However, it should be noted that there was high heterogeneity in the subgroup of women with three or more prior miscarriages.None of the trials reported on any secondary maternal outcomes, including severity of morning sickness, thromboembolic events, depression, admission to a special care unit, or subsequent fertility.There was probably a slight benefit for women receiving Progestogen seen in the outcome of live birth rate (RR 1.11, 95% CI 1.00 to 1.24, 7 trials, 2086 women, moderate-quality evidence). While the rate of preterm birth is probably reduced for women receiving Progestogen, this outcome was mainly driven by one trial and thus should be interpreted with great caution (RR 0.59, 95% CI 0.39 to 0.89, 5 trials, 811 women, moderate-quality evidence). No clear differences were seen for women receiving Progestogen for the other secondary outcomes of neonatal death or fetal genital abnormalities. A possible reduction in stillbirth was seen, but again this outcome was driven mainly by one trial and should be interpreted with caution (RR 0.38, 95% CI 0.24 to 0.58, 3 trials, 1199 women). There may be little or no difference in the rate of low birthweight and trials did not report on the secondary child outcomes of teratogenic effects or admission to a special care unit. Authors' conclusions For women with unexplained recurrent miscarriages, supplementation with Progestogen therapy probably reduces the rate of miscarriage in subsequent pregnancies.
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The Cochrane Library - Progestogen for preventing miscarriage
The Cochrane database of systematic reviews, 2013Co-Authors: David M. Haas, Patrick S. RamseyAbstract:Background Progesterone, a female sex hormone, is known to induce secretory changes in the lining of the uterus essential for successful implantation of a fertilized egg. It has been suggested that a causative factor in many cases of miscarriage may be inadequate secretion of progesterone. Therefore, Progestogens have been used, beginning in the first trimester of pregnancy, in an attempt to prevent spontaneous miscarriage. Objectives To determine the efficacy and safety of Progestogens as a preventative therapy against miscarriage. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 August 2013), reference lists from relevant articles, attempting to contact authors where necessary, and contacted experts in the field for unpublished works. Selection criteria Randomized or quasi-randomized controlled trials comparing Progestogens with placebo or no treatment given in an effort to prevent miscarriage. Data collection and analysis Two review authors assessed trial quality and extracted data. Main results Fourteen trials (2158 women) are included. The meta-analysis of all women, regardless of gravidity and number of previous miscarriages, showed no statistically significant difference in the risk of miscarriage between Progestogen and placebo or no treatment groups (Peto odds ratio (Peto OR) 0.99; 95% confidence interval (CI) 0.78 to 1.24) and no statistically significant difference in the incidence of adverse effect in either mother or baby. A subgroup analysis of placebo controlled trials did not find a difference in the rate of miscarriage with the use of Progestogen (10 trials, 1028 women; Peto OR 1.15; 95% CI 0.88 to 1.50). In a subgroup analysis of four trials involving women who had recurrent miscarriages (three or more consecutive miscarriages; four trials, 225 women), Progestogen treatment showed a statistically significant decrease in miscarriage rate compared to placebo or no treatment (Peto OR 0.39; 95% CI 0.21 to 0.72). However, these four trials were of poorer methodological quality. No statistically significant differences were found between the route of administration of Progestogen (oral, intramuscular, vaginal) versus placebo or no treatment. No significant differences in the rates of preterm birth, neonatal death, or fetal genital anomalies/virilization were found between Progestogen therapy versus placebo/control. Authors' conclusions There is no evidence to support the routine use of Progestogen to prevent miscarriage in early to mid-pregnancy. However, there seems to be evidence of benefit in women with a history of recurrent miscarriage. Treatment for these women may be warranted given the reduced rates of miscarriage in the treatment group and the finding of no statistically significant difference between treatment and control groups in rates of adverse effects suffered by either mother or baby in the available evidence. Larger trials are currently underway to inform treatment for this group of women.
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Progestogen for preventing miscarriage
Cochrane Database of Systematic Reviews, 2013Co-Authors: David M. Haas, Patrick S. RamseyAbstract:Background Progesterone, a female sex hormone, is known to induce secretory changes in the lining of the uterus essential for successful implantation of a fertilized egg. It has been suggested that a causative factor in many cases of miscarriage may be inadequate secretion of progesterone. Therefore, Progestogens have been used, beginning in the first trimester of pregnancy, in an attempt to prevent spontaneous miscarriage. Objectives To determine the efficacy and safety of Progestogens as a preventative therapy against miscarriage. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 August 2013), reference lists from relevant articles, attempting to contact authors where necessary, and contacted experts in the field for unpublished works. Selection criteria Randomized or quasi-randomized controlled trials comparing Progestogens with placebo or no treatment given in an effort to prevent miscarriage. Data collection and analysis Two review authors assessed trial quality and extracted data. Main results Fourteen trials (2158 women) are included. The meta-analysis of all women, regardless of gravidity and number of previous miscarriages, showed no statistically significant difference in the risk of miscarriage between Progestogen and placebo or no treatment groups (Peto odds ratio (Peto OR) 0.99; 95% confidence interval (CI) 0.78 to 1.24) and no statistically significant difference in the incidence of adverse effect in either mother or baby. A subgroup analysis of placebo controlled trials did not find a difference in the rate of miscarriage with the use of Progestogen (10 trials, 1028 women; Peto OR 1.15; 95% CI 0.88 to 1.50). In a subgroup analysis of four trials involving women who had recurrent miscarriages (three or more consecutive miscarriages; four trials, 225 women), Progestogen treatment showed a statistically significant decrease in miscarriage rate compared to placebo or no treatment (Peto OR 0.39; 95% CI 0.21 to 0.72). However, these four trials were of poorer methodological quality. No statistically significant differences were found between the route of administration of Progestogen (oral, intramuscular, vaginal) versus placebo or no treatment. No significant differences in the rates of preterm birth, neonatal death, or fetal genital anomalies/virilization were found between Progestogen therapy versus placebo/control. Authors' conclusions There is no evidence to support the routine use of Progestogen to prevent miscarriage in early to mid-pregnancy. However, there seems to be evidence of benefit in women with a history of recurrent miscarriage. Treatment for these women may be warranted given the reduced rates of miscarriage in the treatment group and the finding of no statistically significant difference between treatment and control groups in rates of adverse effects suffered by either mother or baby in the available evidence. Larger trials are currently underway to inform treatment for this group of women.
Steven L. Monfort - One of the best experts on this subject based on the ideXlab platform.
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effects of dietary fibre on faecal steroid measurements in baboons papio cynocephalus cynocephalus
Reproduction, 1993Co-Authors: Samuel K. Wasser, J Southers, David E. Wildt, R Thomas, P P Nair, C Guidry, J Lucas, Steven L. MonfortAbstract:A study was conducted in captive baboons to determine (i) the impact of cereal dietary fibre on faecal Progestogen excretion, and (ii) whether means of controlling dietary effects could be identified. Blood was collected on 3 days per week and faeces on 5 days per week from four unanaesthetized cyclic female baboons, consecutively fed three diets of 5, 10 and 20% fibre for 90 days per diet. A 2 day lag time was detected before progesterone in the blood appeared in the faeces, regardless of diet (mean correlation was 0.62, P=0.002). Increased dietary fibre had a negative effect on Progestogen excretion (P<0.004). Correspondence between blood and faecal Progestogens was consistently greatest and the effect of dietary fibre least when faecal Progestogens were expressed g -1 dry faeces
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effects of dietary fibre on faecal steroid measurements in baboons papio cynocephalus cynocephalus
Reproduction, 1993Co-Authors: Samuel K. Wasser, J Southers, David E. Wildt, R Thomas, P P Nair, C Guidry, J Lucas, Steven L. MonfortAbstract:A study was conducted in captive baboons to determine (i) the impact of cereal dietary fibre on faecal Progestogen excretion, and (ii) whether means of controlling dietary effects could be identified. Blood was collected on 3 days per week and faeces on 5 days per week from four unanesthetized cyclic female baboons, consecutively fed three diets of 5, 10 and 20% fibre for 90 days per diet. A 2 day lag time was detected before progesterone in the blood appeared in the faeces, regardless of diet (mean correlation was 0.62, P = 0.002). Increased dietary fibre had a negative effect on Progestogen excretion (P < 0.004). Correspondence between blood and faecal Progestogens was consistently greatest and the effect of dietary fibre least when faecal Progestogens were expressed g-1 dry faeces. Several means of indexing faecal steroid excretion rates were examined including dehydroepiandrosterone (DHEA) and a number of byproducts of cholesterol metabolism. The cholesterol metabolite, cholestanone, was positively correlated with dietary fibre (r = 0.27; P < 0.04). Multiplying faecal Progestogen concentration by the cholestanone g-1 dry faeces concentration increased the correlation between serum and cholestanone-indexed faecal Progestogens (r = 0.78, P = 0.0001) compared with nonindexed Progestogens (r = 0.71, P = 0.0001). We conclude that expressing faecal Progestogens g-1 dry faeces may be sufficient and the most cost-effective method for controlling for most dietary effects when the objective is monitoring longitudinal endocrine status in baboons. However, it may be appropriate to express faecal Progestogens by cholestanone concentrations when increased precision is needed to overcome the effects of profound variations in dietary fibre.
Ian S Fraser - One of the best experts on this subject based on the ideXlab platform.
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The Cochrane Library - Progestogens versus oestrogens and Progestogens for irregular uterine bleeding associated with anovulation.
Cochrane Database of Systematic Reviews, 2007Co-Authors: Martha Hickey, Jenny Higham, Ian S FraserAbstract:BACKGROUND: Dysfunctional uterine bleeding (DUB) is "excessively heavy, prolonged or frequent bleeding of uterine origin which is not due to pregnancy or to recognizable pelvic or systemic disease". Anovulation may be inferred from a number of observations but in the normal clinical situation, anovulation is often assumed when a woman presents with heavy, prolonged or frequent bleeding, particularly in those at the extremes of reproductive life and in women known to have the polycystic ovarian syndrome. Menstrual bleeding that is irregular or excessive is usually poorly tolerated by the majority of women. Changes in the length of the menstrual cycle generally imply disturbances of the hypothalamo-pituitary-ovarian (HPO) axis. In anovulatory DUB with acyclic (irregular) oestrogen production there will be no progesterone withdrawal from oestrogen primed endometrium and so cycles are irregular. Prolonged oestrogen stimulation may cause a build up of endometrium with erratic bleeding as it breaks down and is expelled. This is the rationale for using cyclical Progestogens during the second half of the menstrual cycle in order to provoke a regular withdrawal bleed. Continuous Progestogen is intended to induce endometrial atrophy and hence to prevent oestrogen-stimulated endometrial proliferation. Progestogens, and oestrogens and Progestogens in combination are already widely used in the management of irregular or excessive bleeding due to DUB, but the regime, dose and type of Progestogen used varies widely with little consensus about the optimum treatment approach. OBJECTIVES: To determine the effectiveness and acceptability of Progestogens alone, and oestrogens and Progestogens in combination in the management of irregular bleeding associated with anovulation. SEARCH STRATEGY: The search strategy of the Menstrual Disorders Group was used to identify all randomised trials of Progestogens alone or in combination with oestrogens in the management of irregular menstrual bleeding associated with anovulation. In addition a search of the Cochrane Controlled Trials Register was undertaken. SELECTION CRITERIA: All randomised controlled trials of Progestogens (via any route) alone or in combination with oestrogens in the treatment of irregular bleeding associated with anovulation. DATA COLLECTION AND ANALYSIS: Study quality assessment and data extraction were carried out independently by two reviewers. Both reviewers were experts in the content matter. MAIN RESULTS: No randomised trials were identified which compared Progestogens with oestrogens and Progestogens in the management of irregular bleeding associated with anovulation. Only one small, non-randomised study compared two Progestogen regimes in the management of heavy and irregular bleeding in subjects with confirmed anovulation. One randomised study compared the effects of two Progestogens on endometrial histology in subjects with a variety of menstrual symptoms, half of whom had cystic glandular hyperplasia. No studies were found which compared Progestogens with oestrogens and Progestogens in combination or with placebo in the management of irregular bleeding associated with anovulation. REVIEWER'S CONCLUSIONS: There is a paucity of randomised studies relating to the use of Progestogens and of oestrogens and Progestogens in combination in the treatment of irregular bleeding associated with anovulation. Further research is needed to establish the role of these treatments in the management of this common gynaecological problem.
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Progestogens versus oestrogens and Progestogens for irregular uterine bleeding associated with anovulation.
The Cochrane database of systematic reviews, 2000Co-Authors: Martha Hickey, Jenny Higham, Ian S FraserAbstract:Dysfunctional uterine bleeding (DUB) is "excessively heavy, prolonged or frequent bleeding of uterine origin which is not due to pregnancy or to recognizable pelvic or systemic disease". Anovulation may be inferred from a number of observations but in the normal clinical situation, anovulation is often assumed when a woman presents with heavy, prolonged or frequent bleeding, particularly in those at the extremes of reproductive life and in women known to have the polycystic ovarian syndrome. Menstrual bleeding that is irregular or excessive is usually poorly tolerated by the majority of women. Changes in the length of the menstrual cycle generally imply disturbances of the hypothalamo-pituitary-ovarian (HPO) axis. In anovulatory DUB with acyclic (irregular) oestrogen production there will be no progesterone withdrawal from oestrogen primed endometrium and so cycles are irregular. Prolonged oestrogen stimulation may cause a build up of endometrium with erratic bleeding as it breaks down and is expelled. This is the rationale for using cyclical Progestogens during the second half of the menstrual cycle in order to provoke a regular withdrawal bleed. Continuous Progestogen is intended to induce endometrial atrophy and hence to prevent oestrogen-stimulated endometrial proliferation. Progestogens, and oestrogens and Progestogens in combination are already widely used in the management of irregular or excessive bleeding due to DUB, but the regime, dose and type of Progestogen used varies widely with little consensus about the optimum treatment approach. To determine the effectiveness and acceptability of Progestogens alone, and oestrogens and Progestogens in combination in the management of irregular bleeding associated with anovulation. The search strategy of the Menstrual Disorders Group was used to identify all randomised trials of Progestogens alone or in combination with oestrogens in the management of irregular menstrual bleeding associated with anovulation. In addition a search of the Cochrane Controlled Trials Register was undertaken. All randomised controlled trials of Progestogens (via any route) alone or in combination with oestrogens in the treatment of irregular bleeding associated with anovulation. Study quality assessment and data extraction were carried out independently by two reviewers. Both reviewers were experts in the content matter. No randomised trials were identified which compared Progestogens with oestrogens and Progestogens in the management of irregular bleeding associated with anovulation. Only one small, non-randomised study compared two Progestogen regimes in the management of heavy and irregular bleeding in subjects with confirmed anovulation. One randomised study compared the effects of two Progestogens on endometrial histology in subjects with a variety of menstrual symptoms, half of whom had cystic glandular hyperplasia. No studies were found which compared Progestogens with oestrogens and Progestogens in combination or with placebo in the management of irregular bleeding associated with anovulation. There is a paucity of randomised studies relating to the use of Progestogens and of oestrogens and Progestogens in combination in the treatment of irregular bleeding associated with anovulation. Further research is needed to establish the role of these treatments in the management of this common gynaecological problem.
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Effects of Progestogens on human endometrium.
Obstetrical & gynecological survey, 1995Co-Authors: Jing Yu Song, Ian S FraserAbstract:The effect of Progestogens on endometrium depends on the dosage, duration of exposure, the type of Progestogen, and the presence or absence of estrogen. Mechanisms of Progestogen action in endometrium are mainly expressed through the binding of hormone to specific nuclear receptors. Exogenous Progestogens seem to influence the hypothalamic-pituitary-ovarian-endometrial axis differently in different individuals. Endogenous hormones resulting from ovarian secretion have effects on the endometrium independent of, and in combination with, exogenous Progestogens. Endometrial morphological changes with Progestogens vary from suppression of endometrial glandular growth, through stromal decidualization and leukocytic infiltration to glandular atrophy and stromal focal necrosis. In a minority of cases resulting from very prolonged treatment connective tissue fibers increase to some degree and may be accompanied by endometrial fibrosis and calcification. Clinical and histological data have demonstrated that all these changes, including fibrosis and calcification, return to normal in a short period after discontinuing treatment. Endometrial changes during Progestogen therapy are often accompanied by leukocyte infiltration, especially when necrosis occurs. White blood cells constitute an important component of normal endometrium. The number and the type of leukocytes change during the normal menstrual cycle apparently related to circulating ovarian hormonal changes. Exogenous Progestogens also influence white blood cells, by increasing total numbers and certain specific cell types. Changes in endometrial white blood cell function as a consequence of exogenous Progestogens are unclear, but it is possible that the increase of leukocyte infiltration resulting from exogenous Progestogens plays an important role in evoking progestational endometrial necrosis.
David M. Haas - One of the best experts on this subject based on the ideXlab platform.
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Progestogen for preventing miscarriage in women with recurrent miscarriage of unclear etiology
Cochrane Database of Systematic Reviews, 2018Co-Authors: David M. Haas, Taylor J Hathaway, Patrick S. RamseyAbstract:Background Progesterone, a female sex hormone, is known to induce secretory changes in the lining of the uterus essential for successful implantation of a fertilized egg. It has been suggested that a causative factor in many cases of miscarriage may be inadequate secretion of progesterone. Therefore, clinicians use Progestogens (drugs that interact with the progesterone receptors), beginning in the first trimester of pregnancy, in an attempt to prevent spontaneous miscarriage. This is an update of a review, last published in 2013. Objectives To assess the efficacy and safety of Progestogens as a preventative therapy against recurrent miscarriage. Search methods For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (6 July 2017) and reference lists from relevant articles, attempting to contact trial authors where necessary, and contacted experts in the field for unpublished works. Selection criteria Randomized or quasi-randomized controlled trials comparing Progestogens with placebo or no treatment given in an effort to prevent miscarriage. Data collection and analysis Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Two reviewers assessed the quality of the evidence using the GRADE approach. Main results Thirteen trials (2556 women) met the inclusion criteria. Nine of the included trials compared treatment with placebo and the remaining four trials compared Progestogen administration with no treatment. The trials were a mix of multicenter and single-center trials, conducted in Egypt, India, Jordan, UK and USA. In six trials women had had three or more consecutive miscarriages and in seven trials women had suffered two or more consecutive miscarriages. Routes, dosage and duration of Progestogen treatment varied across the trials. The majority of trials were at low risk of bias for most domains. Eleven trials (2359 women) contributed data to the analyses.The meta-analysis of all women, suggests that there is probably a reduction in the number of miscarriages for women given Progestogen supplementation compared to placebo/controls (average risk ratio (RR) 0.69, 95% confidence interval (CI) 0.51 to 0.92, 11 trials, 2359 women, moderate-quality evidence). A subgroup analysis comparing placebo-controlled versus non-placebo-controlled trials and different routes of administration showed no differences between subgroups for miscarriage. However, there appears to be a subgroup difference for miscarriage between women with three or more prior miscarriages compared to women with two or more miscarriages, with a more pronounced effect in women with three or more prior miscarriages. However, it should be noted that there was high heterogeneity in the subgroup of women with three or more prior miscarriages.None of the trials reported on any secondary maternal outcomes, including severity of morning sickness, thromboembolic events, depression, admission to a special care unit, or subsequent fertility.There was probably a slight benefit for women receiving Progestogen seen in the outcome of live birth rate (RR 1.11, 95% CI 1.00 to 1.24, 7 trials, 2086 women, moderate-quality evidence). While the rate of preterm birth is probably reduced for women receiving Progestogen, this outcome was mainly driven by one trial and thus should be interpreted with great caution (RR 0.59, 95% CI 0.39 to 0.89, 5 trials, 811 women, moderate-quality evidence). No clear differences were seen for women receiving Progestogen for the other secondary outcomes of neonatal death or fetal genital abnormalities. A possible reduction in stillbirth was seen, but again this outcome was driven mainly by one trial and should be interpreted with caution (RR 0.38, 95% CI 0.24 to 0.58, 3 trials, 1199 women). There may be little or no difference in the rate of low birthweight and trials did not report on the secondary child outcomes of teratogenic effects or admission to a special care unit. Authors' conclusions For women with unexplained recurrent miscarriages, supplementation with Progestogen therapy probably reduces the rate of miscarriage in subsequent pregnancies.
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The Cochrane Library - Progestogen for preventing miscarriage
The Cochrane database of systematic reviews, 2013Co-Authors: David M. Haas, Patrick S. RamseyAbstract:Background Progesterone, a female sex hormone, is known to induce secretory changes in the lining of the uterus essential for successful implantation of a fertilized egg. It has been suggested that a causative factor in many cases of miscarriage may be inadequate secretion of progesterone. Therefore, Progestogens have been used, beginning in the first trimester of pregnancy, in an attempt to prevent spontaneous miscarriage. Objectives To determine the efficacy and safety of Progestogens as a preventative therapy against miscarriage. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 August 2013), reference lists from relevant articles, attempting to contact authors where necessary, and contacted experts in the field for unpublished works. Selection criteria Randomized or quasi-randomized controlled trials comparing Progestogens with placebo or no treatment given in an effort to prevent miscarriage. Data collection and analysis Two review authors assessed trial quality and extracted data. Main results Fourteen trials (2158 women) are included. The meta-analysis of all women, regardless of gravidity and number of previous miscarriages, showed no statistically significant difference in the risk of miscarriage between Progestogen and placebo or no treatment groups (Peto odds ratio (Peto OR) 0.99; 95% confidence interval (CI) 0.78 to 1.24) and no statistically significant difference in the incidence of adverse effect in either mother or baby. A subgroup analysis of placebo controlled trials did not find a difference in the rate of miscarriage with the use of Progestogen (10 trials, 1028 women; Peto OR 1.15; 95% CI 0.88 to 1.50). In a subgroup analysis of four trials involving women who had recurrent miscarriages (three or more consecutive miscarriages; four trials, 225 women), Progestogen treatment showed a statistically significant decrease in miscarriage rate compared to placebo or no treatment (Peto OR 0.39; 95% CI 0.21 to 0.72). However, these four trials were of poorer methodological quality. No statistically significant differences were found between the route of administration of Progestogen (oral, intramuscular, vaginal) versus placebo or no treatment. No significant differences in the rates of preterm birth, neonatal death, or fetal genital anomalies/virilization were found between Progestogen therapy versus placebo/control. Authors' conclusions There is no evidence to support the routine use of Progestogen to prevent miscarriage in early to mid-pregnancy. However, there seems to be evidence of benefit in women with a history of recurrent miscarriage. Treatment for these women may be warranted given the reduced rates of miscarriage in the treatment group and the finding of no statistically significant difference between treatment and control groups in rates of adverse effects suffered by either mother or baby in the available evidence. Larger trials are currently underway to inform treatment for this group of women.
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Progestogen for preventing miscarriage
Cochrane Database of Systematic Reviews, 2013Co-Authors: David M. Haas, Patrick S. RamseyAbstract:Background Progesterone, a female sex hormone, is known to induce secretory changes in the lining of the uterus essential for successful implantation of a fertilized egg. It has been suggested that a causative factor in many cases of miscarriage may be inadequate secretion of progesterone. Therefore, Progestogens have been used, beginning in the first trimester of pregnancy, in an attempt to prevent spontaneous miscarriage. Objectives To determine the efficacy and safety of Progestogens as a preventative therapy against miscarriage. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 August 2013), reference lists from relevant articles, attempting to contact authors where necessary, and contacted experts in the field for unpublished works. Selection criteria Randomized or quasi-randomized controlled trials comparing Progestogens with placebo or no treatment given in an effort to prevent miscarriage. Data collection and analysis Two review authors assessed trial quality and extracted data. Main results Fourteen trials (2158 women) are included. The meta-analysis of all women, regardless of gravidity and number of previous miscarriages, showed no statistically significant difference in the risk of miscarriage between Progestogen and placebo or no treatment groups (Peto odds ratio (Peto OR) 0.99; 95% confidence interval (CI) 0.78 to 1.24) and no statistically significant difference in the incidence of adverse effect in either mother or baby. A subgroup analysis of placebo controlled trials did not find a difference in the rate of miscarriage with the use of Progestogen (10 trials, 1028 women; Peto OR 1.15; 95% CI 0.88 to 1.50). In a subgroup analysis of four trials involving women who had recurrent miscarriages (three or more consecutive miscarriages; four trials, 225 women), Progestogen treatment showed a statistically significant decrease in miscarriage rate compared to placebo or no treatment (Peto OR 0.39; 95% CI 0.21 to 0.72). However, these four trials were of poorer methodological quality. No statistically significant differences were found between the route of administration of Progestogen (oral, intramuscular, vaginal) versus placebo or no treatment. No significant differences in the rates of preterm birth, neonatal death, or fetal genital anomalies/virilization were found between Progestogen therapy versus placebo/control. Authors' conclusions There is no evidence to support the routine use of Progestogen to prevent miscarriage in early to mid-pregnancy. However, there seems to be evidence of benefit in women with a history of recurrent miscarriage. Treatment for these women may be warranted given the reduced rates of miscarriage in the treatment group and the finding of no statistically significant difference between treatment and control groups in rates of adverse effects suffered by either mother or baby in the available evidence. Larger trials are currently underway to inform treatment for this group of women.
Samuel K. Wasser - One of the best experts on this subject based on the ideXlab platform.
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effects of dietary fibre on faecal steroid measurements in baboons papio cynocephalus cynocephalus
Reproduction, 1993Co-Authors: Samuel K. Wasser, J Southers, David E. Wildt, R Thomas, P P Nair, C Guidry, J Lucas, Steven L. MonfortAbstract:A study was conducted in captive baboons to determine (i) the impact of cereal dietary fibre on faecal Progestogen excretion, and (ii) whether means of controlling dietary effects could be identified. Blood was collected on 3 days per week and faeces on 5 days per week from four unanaesthetized cyclic female baboons, consecutively fed three diets of 5, 10 and 20% fibre for 90 days per diet. A 2 day lag time was detected before progesterone in the blood appeared in the faeces, regardless of diet (mean correlation was 0.62, P=0.002). Increased dietary fibre had a negative effect on Progestogen excretion (P<0.004). Correspondence between blood and faecal Progestogens was consistently greatest and the effect of dietary fibre least when faecal Progestogens were expressed g -1 dry faeces
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effects of dietary fibre on faecal steroid measurements in baboons papio cynocephalus cynocephalus
Reproduction, 1993Co-Authors: Samuel K. Wasser, J Southers, David E. Wildt, R Thomas, P P Nair, C Guidry, J Lucas, Steven L. MonfortAbstract:A study was conducted in captive baboons to determine (i) the impact of cereal dietary fibre on faecal Progestogen excretion, and (ii) whether means of controlling dietary effects could be identified. Blood was collected on 3 days per week and faeces on 5 days per week from four unanesthetized cyclic female baboons, consecutively fed three diets of 5, 10 and 20% fibre for 90 days per diet. A 2 day lag time was detected before progesterone in the blood appeared in the faeces, regardless of diet (mean correlation was 0.62, P = 0.002). Increased dietary fibre had a negative effect on Progestogen excretion (P < 0.004). Correspondence between blood and faecal Progestogens was consistently greatest and the effect of dietary fibre least when faecal Progestogens were expressed g-1 dry faeces. Several means of indexing faecal steroid excretion rates were examined including dehydroepiandrosterone (DHEA) and a number of byproducts of cholesterol metabolism. The cholesterol metabolite, cholestanone, was positively correlated with dietary fibre (r = 0.27; P < 0.04). Multiplying faecal Progestogen concentration by the cholestanone g-1 dry faeces concentration increased the correlation between serum and cholestanone-indexed faecal Progestogens (r = 0.78, P = 0.0001) compared with nonindexed Progestogens (r = 0.71, P = 0.0001). We conclude that expressing faecal Progestogens g-1 dry faeces may be sufficient and the most cost-effective method for controlling for most dietary effects when the objective is monitoring longitudinal endocrine status in baboons. However, it may be appropriate to express faecal Progestogens by cholestanone concentrations when increased precision is needed to overcome the effects of profound variations in dietary fibre.
